Moramarco Lorenzo, Grande Antonino M, Vertemati Maurizio, Aseni Paolo
Radiologia-Neuroradiologia Diagnostica ed Interventistica, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
Divisione Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
J Clin Med. 2023 Dec 22;13(1):65. doi: 10.3390/jcm13010065.
Lower urinary tract symptoms (LUTS) and hematuria are common symptoms in men with neoplasms, mainly affecting the elderly population. Prostatic arterial embolization (PAE) is a minimally invasive procedure that has shown promising results in managing LUTS and massive intractable prostatic hematuria in patients with benign prostatic hyperplasia (BPH) and prostate cancer (PCa). A few studies, however, have provided valuable insights into the durability and efficacy of PAE focusing on the long-term effectiveness, quality of life, and cancer-specific control of hemostasis and urinary symptoms. As a result of concomitant cardiovascular conditions, these patients often take anticoagulants or antithrombotics, which can worsen their hematuria and clinical status. Transurethral resection of the prostate (TURP) is considered a very high-risk procedure, even without massive bleeding, and requires discontinuation of vitamin K antagonists and antiplatelet therapies. Such patients usually have their surgery postponed, and PAE should be considered a safe alternative treatment. We aimed to report a narrative review from 1976 to June 2023 of the current state of PAE for massive and intractable hematuria, highlighting recent developments in this technique, including prospective cohort studies, and focusing on long-term outcome, safety, and complication management of patients with prostatic neoplasms who develop significant hemorrhagic symptoms. Additionally, we present a case report and a simple algorithm for treating intractable bleeding in a 92-year-old man with PCa and massive hematuria.
下尿路症状（LUTS）和血尿是肿瘤男性患者的常见症状，主要影响老年人群。前列腺动脉栓塞术（PAE）是一种微创手术，在治疗良性前列腺增生（BPH）和前列腺癌（PCa）患者的LUTS及大量难治性前列腺血尿方面已显示出有前景的结果。然而，少数研究针对PAE的持久性和疗效提供了有价值的见解，重点关注长期有效性、生活质量以及止血和泌尿系统症状的癌症特异性控制。由于并存心血管疾病，这些患者常服用抗凝剂或抗血栓药物，这可能会使他们的血尿和临床状况恶化。经尿道前列腺切除术（TURP）即使在没有大量出血的情况下也被认为是一项高风险手术，并且需要停用维生素K拮抗剂和抗血小板治疗。这类患者通常会推迟手术，而PAE应被视为一种安全的替代治疗方法。我们旨在报告一篇从1976年至2023年6月关于PAE治疗大量难治性血尿现状的叙述性综述，突出该技术的最新进展，包括前瞻性队列研究，并关注出现严重出血症状的前列腺肿瘤患者的长期结局、安全性和并发症管理。此外，我们还展示了一例病例报告以及一种治疗一名92岁患有PCa和大量血尿男性难治性出血的简单算法。
